Dental Tribune Middle East & Africa Edition No.2, 2016

Dental Tribune Middle East & Africa Edition | 2/2016 endo tribune 2 Anatomical pin: A clinical case report By Profs. Frederico dos Reis Goyatá &OrlandoIzolaniNeto,Brazil Endodontic treatment of teeth with significant coronal destruction is a very common clinical procedure in the restorative clinical practice. When we are faced with this clinical situation, there will be an eminent need for the use of intra-radicular retainers to obtain greater stability and retention of the restoration to theremainingteeth.[1,2] The use of an anatomical pin is proposed for the rehabilitation of anterior teeth with extensively com- promisedrootcanalsandwithsignif- icant loss of dentine tissue. [3] In this restorative method, in addition to the fibreglass pin, a compound resin is used to model the radicular con- duit with the objective of reducing the space that would be filled by the resin cement. In this way, the combi- nation of two restorative materials (pin and compound resin) will serve and behave biomechanically as a re- placement of the dentine structure lost.[4] Anatomical pins have an extremely favourable prognosis in cases of fragile roots due to loss of dentine structure and they contribute sig- nificantly to the rehabilitation of the tooth in terms of both masticatory function and aesthetics. [5] In addi- tion, the fibreglass pins have a more uniform distribution of tension in the occlusal and radicular regions compared with metal pins. [6] Etch- ingandsilanisationofthepinsareof the utmost importance for pro mot- ing interfacial adherence, especially in the region prepared for the core. [7,8] This study reports on a clinical case that demonstrates the preparation technique for the anatomical pin, using fibreglass pins and compound resin, in a maxillary central incisor with weakened roots, with the ob- jective of re-establishing the coronal portionofthetooth. Casereport A young male patient came into the integrated dentistry clinic at Uni- versidade Severino Sombra needing restorativetreatmentoftooth#21.In the clinical and radiographic exami- nation, significant coronal destruc- tion and satisfactory endodontic treatmentwerenoted(Figs.1–3). Restoration with an anatomical pin wasproposedtothepatient,inorder to recover the function and aesthet- ics of the tooth and provide for fu- ture rehabilitation of the tooth with afullceramiccrown. First, the decayed tissue was re- moved from the remaining tooth structure and the fibreglass pin was selected (Exacto # 3, Angelus), as well as the accessory pins (Reforpin, An- gelus; Fig. 4). The radicular conduit was isolated with mineral oil and the compound resin was applied (Fill Magic NT Premium, Vigodent/ COLTENE) over the remaining tooth (Figs. 5 & 6) with the aid of a #1/2 Su- prafill spatula (SS White). After filling of the conduit with resin, the Exacto pin and the pre-silanised accessory pins (Silano, Angelus) were inserted with the application of an adhesive (Fusion-Duralink, Angelus; Figs. 7–9). Next, the initial photoactivation was conducted on the pin and resin for 20seconds. Finally, the coronal reconstruction was performed with the previously used compound resin in incremen- talportionsandphotoactivationwas conducted (Figs. 10 & 11). A marking was made on the most incisal por- tion of the pins to guide the subse- quent cropping of the pins (Fig. 12). The anatomical pin was then re- movedandthefinalphotoactivation was performed for 40 seconds (Fig. 13). Soon after, the pin was adapted to the remaining coronal structure (Fig.14). Fig.1 Fig.9 Fig.14 Fig.18 Fig.5 Fig.3 Fig.11 Fig.16 Fig.20 Fig.7 Fig.2 Fig.10 Fig.15 Fig.19 Fig.6 Fig.4 Fig.12 Fig.17 Fig.21 Fig.8 ÿPage3